Provider Reimburse Admin / Provider Reimburse Admin Sr
Company: Anthem, Inc
Posted on: February 11, 2020
Provider Reimburse Admin / Provider Reimburse Admin Sr -
PS31797Location: Virginia, United StatesRequisition #: PS31797Post
Date: Jan 16, 2020Your Talent. Our Vision. AtAnthem, Inc., its a
powerful combination, and the foundation upon which werecreating
greater access to care for our members, greater value for
ourcustomers, and greater health for our communities. Join us and
together wewill drive the future of health care .This is an
exceptional opportunityto do innovative work that means more to you
and those we serve at one ofAmerica's leading health benefits
companies and a Fortune Top 50 Company.Provider Reimbursement Admin
orProvider Reimbursement Admin Sr.Open to most locations including
aremote (work-at-home) arrangementEnsures accurate adjudication
ofclaims by translating provider contracts, reimbursement policies,
CMSguidelines, and medical policies into effective and accurate
reimbursementconfiguration in FACETS NetworX.Primary duties for
both levels mayinclude, but are not limited to:
- Reviewing provider contracts together with Anthem andCMS
guidelines to ensure compliant and accurate configuration of
- Analyzing each new provider contract for coverage,policy,
reimbursement development, and implications for system edits.
- Configuring FACETS NetworX with provider reimbursementterms,
PCAs, fee schedules, and code sets.
- Responding to system inquiries and appeals-- primarilyin order
to troubleshoot claims adjudication issues relatedto
- Conducting research of claims systems and system editsto
identify issues and to audit claims adjudication for accuracy.
- Creating test claims and performing reviews of claimsto ensure
proper configuration was used.
- Working with other departments to resolve systemissues.
- Working with provider contracting staff whennew/modified
reimbursement contracts are needed.
- Assisting with the analysis, documentation,configuration, and
testing of current and future marketsbusiness requirements.
- Supporting the upgrade of test environments.In addition to the
above, the SR level positionserves as a subject matter expert
regarding FACETS NetworXcoding conventions, reimbursement policies,
provider contract language,claims testing, system edits, and FACETS
backend tables.These additional primary duties mayalso include, but
not limited to:
- Works with vendors and enterprise teams to developenterprise
reimbursement policies and edits, ensuring policies andedits do not
conflict with Federal and statemandates.
- Works with other departments on claims adjudicationworkflow
development and business process improvements.
- May lead the full range of provider reimbursementactivities for
- Leads projects related to provider
- Creates queries and performs updates to backend tablesusing SQL
- Serves as a mentor to less experienced
administrators.ProviderReimbursement Admin / SR
qualifications:TheSR level requires a BA/BS degree; 4+ years (2+
for junior level) relatedexperience; or any combination of
education and experience, which wouldprovide an equivalent
background.Bothlevels must have demonstrated knowledge and
experience in the areas which isrequired for the
role.Requirements:-Ability to handle analytical work where
independent thinking and problemsolving is demonstrated-Ability to
leverage data to make logical conclusions-FACETS pricing
configuration, benefit build, or similar experience-FACETS NetworX
experience, or similar applications-Able to run Microsoft Access
queries in relation to Facets-Strong mind for process-Must know how
to read and analyze a contract-Experience handling large
projects-Able to use full range of Microsoft Office products
proficiently Preferredskills and experience:-Inaddition to the
above skills and experience, the SR level would need to possessthe
ability to perform backend table updates using Microsoft Access
orSQL.Anthem,Inc. is ranked as one of Americas Most Admired
Companies among health insurersby Fortune magazine and is a 2018
DiversityInc magazine Top 50 Company forDiversity. To learn more
about our company and apply, please visit us
atcareers.antheminc.com. An Equal Opportunity
Keywords: Anthem, Inc, Clearwater , Provider Reimburse Admin / Provider Reimburse Admin Sr, Administration, Clerical , Clearwater, Florida
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